Provider Demographics
NPI:1396123386
Name:SHAHI, AVJIT
Entity type:Individual
Prefix:
First Name:AVJIT
Middle Name:
Last Name:SHAHI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:83 TEMPLETON DR
Mailing Address - Street 2:STE F
Mailing Address - City:OSWEGO
Mailing Address - State:IL
Mailing Address - Zip Code:60543-7025
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:83 TEMPLETON DR STE F
Practice Address - Street 2:
Practice Address - City:OSWEGO
Practice Address - State:IL
Practice Address - Zip Code:60543-7025
Practice Address - Country:US
Practice Address - Phone:630-554-8002
Practice Address - Fax:630-554-8095
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-11
Last Update Date:2020-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046011058152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist